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The dimension of preventable stroke in a large representative patient cohort.
Journal article

The dimension of preventable stroke in a large representative patient cohort.

  • Boehme C From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Toell T From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Mayer L From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Domig L From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Pechlaner R From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Willeit K From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. stefan.kiechl@i-med.ac.at johann.willeit@i-med.ac.at.
  • Tschiderer L From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Seekircher L From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Willeit P From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. stefan.kiechl@i-med.ac.at johann.willeit@i-med.ac.at.
  • Griesmacher A From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Knoflach M From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria.
  • Willeit J From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. stefan.kiechl@i-med.ac.at johann.willeit@i-med.ac.at.
  • Kiechl S From the Department of Neurology (C.B., T.T., L.M., L.D., R.P., K.W., L.T., L.S., P.W., M.K., J.W., S.K.), Medical University of Innsbruck, Austria; Department of Neurology (K.W.), Inselspital, University Hospital of Bern, Switzerland; Department of Public Health and Primary Care (P.W.), University of Cambridge, UK; and Central Institute for Medical and Chemical Laboratory Diagnosis (A.G.), Medical University of Innsbruck, Austria. stefan.kiechl@i-med.ac.at johann.willeit@i-med.ac.at.
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  • 2019-11-02
Published in:
  • Neurology. - 2019
Adult
Aged
Cohort Studies
Female
Guideline Adherence
Humans
Male
Middle Aged
Primary Prevention
Risk Factors
Stroke
English OBJECTIVE
To analyze the frequency of inadequately treated risk factors in a large representative cohort of patients with acute ischemic stroke or TIA and to estimate the proportion of events potentially avertable by guideline-compliant preventive therapy compared to the status quo.


METHODS
A total of 1,730 patients from the Poststroke Disease Management STROKE-CARD trial (NCT02156778) were recruited between 2014 and 2017. We focused on 8 risk conditions amenable to drug therapy and 3 lifestyle risk behaviors and assessed pre-event risk factor control in retrospect.


RESULTS
The proportion of patients with at least 1 inadequately treated risk condition was 79.5% (95% confidence interval [CI] 77.6%-81.4%) and increased to 95.1% (95% CI 94.1%-96.1%) upon consideration of the lifestyle risk behaviors. Risk factor control was worse in patients with recurrent vs first-ever events (p < 0.001), men vs women (p = 0.003), and patients ≤75 vs >75 years of age (p < 0.001). The estimated degree of stroke preventability ranged from 0.4% (95% CI 0.2%-0.6%) to 13.7% (95% CI 12.2%-15.2%) for the individual risk factors. Adequate control of the 5 most relevant risk factors combined (hypertension, hypercholesterolemia, atrial fibrillation, smoking, and overweight) would have averted ≈1 of 2 events or 1 in 4 with a highly conservative computation approach.


CONCLUSIONS
Our study confirms the existence of a considerable gap between risk factor control recommended by guidelines and real-world stroke prevention. Our study intends to increase awareness among physicians about stroke preventability and provides a quantitative basis for the emerging discussion on how to best tackle this challenge.
Language
  • English
Open access status
closed
Identifiers
Persistent URL
https://sonar.ch/global/documents/284520
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